What’s New in the Postoperative Management of Crohn’s Disease? View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2021-08-18

AUTHORS

Sonya S. Dasharathy, Berkeley N. Limketkai, Jenny S. Sauk

ABSTRACT

Patients with Crohn’s disease (CD) often require surgical resection due to complications, such as strictures and abscesses, or disease refractory to medical therapy. To understand the evolving management of patients with CD after surgery, we outline the risk factors for postoperative recurrence, advances in postoperative endoscopic evaluation and characterization of recurrence, noninvasive methods of assessing postoperative recurrence, use of postoperative prophylactic medical therapy including newer biologics, and novel surgical methods to reduce postoperative recurrence. The Rutgeerts score (RS) was developed to predict progression of disease based on endoscopic appearance postoperatively and to guide medical therapy. However, this scoring system groups ileal and anastomotic lesions into the same category. A modified RS was developed to separate lesions isolated to the anastomosis and those in the neo-terminal ileum to further understand the role of anastomotic lesions in CD progression. Additional scoring systems have also been evaluated to better understand these differences. In addition, noninvasive diagnostic methods, such as small bowel ultrasound, have high sensitivity and specificity for the detection of postoperative recurrence and are being evaluated as independent methods of assessment. Studies have also shown a reduction in endoscopic recurrence with postoperative anti-TNFα therapy. However, preoperative exposure to anti-TNFα therapy may impact postoperative response to these medications, and therefore, determining optimal postoperative prophylaxis strategy for biologic-experienced patients requires further exploration. Lastly, new surgical modalities to reduce postoperative recurrence are currently being investigated with preliminary data suggesting that an antimesenteric functional end-to-end anastomosis (Kono-S) may decrease postoperative recurrence. More... »

PAGES

3508-3517

References to SciGraph publications

  • 2014-02-06. Stapled Side-to-Side Anastomosis Might Be Better Than Handsewn End-to-End Anastomosis in Ileocolic Resection for Crohn’s Disease: A Meta-Analysis in DIGESTIVE DISEASES AND SCIENCES
  • 2007-08-08. A Meta-Analysis Comparing Conventional End-to-End Anastomosis vs. Other Anastomotic Configurations After Resection in Crohn’s Disease in DISEASES OF THE COLON & RECTUM
  • 2008-05-27. Anastomotic recurrence of Crohn’s disease after ileocolic resection: comparison of MR enteroclysis with endoscopy in EUROPEAN RADIOLOGY
  • 2013-08-22. Association of gut microbiota with post-operative clinical course in Crohn’s disease in BMC GASTROENTEROLOGY
  • 2008-01-03. Inflammatory activity in Crohn disease: ultrasound findings in ABDOMINAL RADIOLOGY
  • 2008-09-02. The effect of smoking after surgery for Crohn’s disease: a meta-analysis of observational studies in INTERNATIONAL JOURNAL OF COLORECTAL DISEASE
  • 2018-10-23. Surgical Recurrence at Anastomotic Site After Bowel Resection in Crohn’s Disease: Comparison of Kono-S and End-to-end Anastomosis in JOURNAL OF GASTROINTESTINAL SURGERY
  • 2019-01-02. Intravenous Contrast-Enhanced Ultrasound for Assessing and Grading Postoperative Recurrence of Crohn’s Disease in DIGESTIVE DISEASES AND SCIENCES
  • 2007-09-25. A Meta-Analysis Comparing Incidence of Recurrence and Indication for Reoperation After Surgery for Perforating Versus Nonperforating Crohn's Disease in THE AMERICAN JOURNAL OF GASTROENTEROLOGY
  • 2020-02-21. Mesenteric excision surgery or conservative limited resection in Crohn’s disease: study protocol for an international, multicenter, randomized controlled trial in TRIALS
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    http://scigraph.springernature.com/pub.10.1007/s10620-021-07205-w

    DOI

    http://dx.doi.org/10.1007/s10620-021-07205-w

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1140498091

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/34406585


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